Following a recent groundbreaking study that reveals the uselessness of pelvic exams, the media coverage is focusing on the continued debate between the American College of Physicians and the ob-gyns, rather than on the implications for women’s health. The Physicians group is claiming the evidence from the study is sufficient to recommend scrapping routine pelvic exams, while the ob-gyns are arguing that there is justification for maintaining the exam practice. The debate has absorbed much of the public’s attention, but there are some important points that are being ignored in the process:
- Given the absence of evidence to support the efficacy of pelvic exams, why have doctors been performing them . . . for many years?
- Until recently, many doctors have failed to acknowledge the invasive and humiliating nature of pelvic exams. In fact, women have often been scolded or chastised when they speak up about the embarrassment and/or request female practitioners.
- The study revealed that no one has been keeping track of the numbers of women who have been unnecessarily harmed due to over-diagnosis and over-treatment. How many women have suffered psychological trauma and unnecessary physical harms? To what extent have these harms affected their health, peace of mind, and ability to reproduce?
- No one has been keeping track of the numbers of times an illness or disease goes undetected due to the disproportionate focus on women’s reproductive organs.
- Women are not being offered informed consent in regards to pelvic exams. In fact, many women face coercion when doctors withhold birth control pills, other medications, and treatment, when they attempt to decline a pelvic exam/pap test.
- No one has been keeping track of the numbers of women who avoid doctors due to pelvic exam coercion.
The recent study and ensuing debate is encouraging, but the coverage continues to ignore and/or downplay the bigger issues in women’s health care.
Keep on preaching your truth! It is a vitally important message that needs to be heard by women and healthcare professionals the world over. Your questions are not only valid…..they are dead on. Thanks for what you are doing
I feel that this article at http://www.cnn.com/2014/07/09/health/pelvic-exam-opinion/ is misguided. I am sure that many doctors will continue to push patients into having unnecessary pelvic exams.
The cnn article …. All the doctor of the forty year old woman had to do was ask if this woman had any concerns about her bowel habits and give her an FOBT or more accurate FIT test. The she could have been referred for a colonoscopy or ultrasound if necessary. Sticking fingers in a vagina is also not necessary to feel a mass in the colon.
For some women who live where there are pap registries women are being monitored. I hardly think that when they have my health card number, name, date of birth, they can also access my ehealth records and find out now much I use the health system. But the only way I can highlight the coercion factor is to complain to my member of provincial partiament. The new government in Ontario appointed an MD as the minster of health. Somehow I think there will be bias.
Anonymous, I have heard the FOB test is inaccurate and can lead to unnecessary and potentially harmful follow ups. Although, given a choice between a pelvic and FOB test in the forty year old woman’s situation, the FOBT would be the more appropriate option, I agree.
The minister of health in Ontario is an MD (Eric Hoskins), but Premier Kathleen Wynne appointed Deb Matthews as chair of the Treasury Board. Matthews was responsible for the new directive in Ontario which states pap tests will be paid for every three years, and women seeking an annual pap test will have to pay for it out of pocket. Matthews is attempting to stymie unnecessary, harmful over testing. Matthews directive received this response:
(The following letter was addressed to Ontario Premier Kathryn Wynne and a copy was filed with the Champion.)
Dear Premier Wynne:
It has come to my attention that doctors in Ontario have received a directive from the office of the Minister of Health, Deb Matthews, that future pap tests for women are to be conducted on a three-year basis rather than yearly.
Doctors have devoted years stressing the importance of yearly pap tests, not as an excuse to bill OHIP, but because of their dedication to the overall welfare of their patients.
I believe a three-year interval between tests for many could prove devastating and in some cases fatal. The cost of a pap test versus that of prolonged treatment is insignificant. In other words, as the saying goes, “an ounce of prevention is worth a pound of cure.”
Literature from the Cancer Research Society indicates it’s diligently working with some success toward a cure for cancer. A restriction on yearly pap tests, in my view, is a giant step backward.
If this is Matthews’ attempt to cut expenses, I suggest she go back to the drawing board. No one has the right to play Russian roulette with people’s lives. I think this directive, especially coming from a woman, is offensive, incomprehensible, and definitively should be reversed.
The MD who has been appointed as Minister of Health will be monitored by Matthews, and I see this as a very good thing in regards to women’s health and happiness. Deb Matthews is clearly against unnecessary, harmful excess.
This Drs response to the article is interesting:
I’m a physician and I’ve been doing pelvic exams for years. I cannot say that I ever once had a finding on a bimanual exam for an asymptomatic woman that led to a clinically significant diagnosis. Note that I say asymptomatic. If a woman comes in with a pelvic related complaint, of course you’re going to do an exam and see what’s going on. But sticking my fingers in a 25 year old female who is otherwise healthy with zero complaints is an extremely low yield test, leads to a lot of false positive findings and leads to wild goose chases. By the time you find an ovarian cancer via bimanual exam, it’s pretty much game over at that point anyway (with very rare exception).
The whole story about the woman where the precancerous colon polyps were found, that was dumb luck. Lots of women have discomfort in doing a bimanual exam; she probably had already been through a pelvic CT scan, pelvic ultrasound, endometrial biopsy, etc etc before having a colonoscopy to find polyps that were very unlikely to grow to a significant size by the time she was 50 anyway.
We are having the same discussion about PSA testing and regular prostate exams for men. For every one guy’s life you might save, you’re going to put at least ten through a likely unnecessary prostatectomy. Does that mean I don’t do them? No, I do them in discussion and agreement with the patient, but in the past four years being at my current practice I’ve caught one asymptomatic guy with an elevated PSA and normal DRE that had a clinically aggressive cancer. I’ve seen way more elevated PSAs that have caused a lot of sleepless nights, lot of worry, and lot of unnecessary procedures.
Are you going to save that occasional person? Sure you are, but it’s like the argument for putting people sensors in cars to save those 44 kids a year that die in hot cars. Or making everyone take their shoes off at the airport. How expensive and incovenienced are you going to make everyone for that effort to save maybe a hundred people a year? The physician in me wants to save EVERYONE all the time….but that’s not realistic.
The utility of pelvic exams (and frankly, lots of other preventive health tests in asymptomatic persons) has been debated for years, this is nothing new just so the laypeople understand that ‘Obamacare’ hasn’t created these controversies and questions. It probably has brought it to the forefront because now we’re talking about health care and having to make some decisions about what’s cost effective and what’s not. We are a nation that loves tests and procedures. Patients like them because they think we’re ‘doing something about it’ (when in fact, hint hint, we’re usually just placating your demands to ‘do something’) and we order them because patients want them, and woe to me if I judge wrong and miss the occasional serious pathology by not getting the MRI for the shoulder pain that’s been ongoing for two weeks. .
If it makes you sleep better at night and gives you peace of mind, then go ahead and get the annual pelvic exam. Just be aware of what the consequences of them can be, both good and bad. A normal exam doesn’t mean you don’t have pathology lying there, we just can’t feel it most of the time.
ADM – It’s good to know that some doctors are being honest and trying to make patients informed. I am curious about something, though. He said that finding ovarian cancer via bimanual exam is pretty much game over any way. This statement would imply that you can not typically feel anything in an exam which would lead you to diagnose someone with cancer, and in many cases, women are over diagnosed. Yet he supports performing exams on symptomatic women. Correct me if I’m wrong here, but wouldn’t some sort of ultrasound or scan be much more accurate than a bimanual exam? Would it not be able to more effeciently detect the issue? I’m not as knowledgeable as some, so I might be wrong. It’s just that logically thinking, it seems to me that those options might be better all-around.
There is no screening test for ovarian cancer – ultrasounds, routine pelvic exams, CA-125 blood test all lead to false positives and that can mean unnecessary surgery.
As far as evidence based medicine is concerned, these tests and exam are NOT recommended in symptom-free women. None are of any proven benefit. I wouldn’t permit any of them.
Of course, women have been scared to death about this rare cancer, more common than cervical cancer, but still on the rare side, so some women feel they should be doing “something”. I disagree, if it doesn’t help and exposes you to risk, why bother?
I know some high risk women have regular ultrasounds etc. usually those with a faulty BRCA1 gene.
I heard some bright spark say nuns should use the Pill to reduce the risk of ovarian cancer, they ovulate every month and don’t have children. Ummm, that last bit is not true, some women join the Order later in life and some have biological children. Some take the Pill too, for heavy periods etc.
Also, I ovulated every month, the Pill was OUT thanks to medical barriers (I wasn’t going there! I also, had other reservations about the Pill) so did my ancestors and no one developed ovarian cancer. So aside from nuns, following this reasoning, we’d also include women who’ve never taken the Pill and have had no pregnancies.
That sort of thinking does not appeal to me, what next? Have them out, just in case…why not all women after they finish having kids? When we no longer “need” them.
Why not take the lot, that way you reduce the risk of uterine and cervical cancer? It’s dysfunctional thinking, perverse.
Of course, we need our organs right through life. Women should be cautious agreeing to a hysterectomy, is it really necessary? Often there are other measures that can sort out things like fibroids, endometriosis etc. 600,000 American women have a hysterectomy every year, how many are really necessary? How many are victims of the “better out, than in” medical brigade?
Elizabeth – Thanks for the reply! However, my comment was NOT in regards to screening for Ovarian cancer or asymptomatic women. Personally, I don’t see the point and I know far too many young women personally who have had benign cysts removed and were told they should be thankful nothing was wrong. I was questioning if a pelvic exam is of any use for symptomatic women, since the doctor made the claim that it was. My logic is that if something isn’t accurate or reliable in one situation, then it can’t possibly be accurate and reliable in another. Logically speaking, it would seem that some sort of ultrasound or scan or blood test would be much more accurate for diagnosis in symptomatic women. Even in the case of a symptomatic woman, if they “felt” something, there’s still no guarantee that it’s cancerous or even the root of the problem, since there are already so many false-positives with this exam for asymptomatic women.
Ro, you’re right, I’ve read the pelvic exam is of poor clinical value even with symptomatic women. I read an interesting article about that fairly recently. If I can find it, I’ll provide the link.
Do you educate your female patients about the new recommendations (2014) for pelvic exams for healthy, non pregnant women without symptoms, or do you keep them in the dark and badger them into letting you violate them by doing a pelvic exam without medical causes?
Well my doctor have one despite a hyster in1985. There were abnormal souls. I have now had a follow up one and am awaiting the results. Hugs, Barbara
It’s nice to see you Barbara! Thank you for the reblog . . . once again so many likes magically appear:) I’m sending good wishes your way and hoping everything turns out well for you.
Thank you. I am happy to help. Hugs, Barbara
Despite the evidence: “an alarming number of physicians continue to conduct annual pelvic exams” http://blogs.reuters.com/great-debate/2014/08/05/you-dont-need-that-annual-pelvic-exam-so-why-is-your-doctor-giving-you-one It’s encouraging that a physician is asking why so many doctors are still performing annual pelvic exams. I wonder why there are no laws set in place to ensure physicians’ practices are based on evidence.
That’s, I think, because they have a sense of being their own culture (in a sense of the word). They feel that “these are the ways of our people” & are not familiar with the concept of someone telling them “No, they’re not.” All the time doctors get left alone if their behavior is bad (whether that means antagonistic or incompetant)- the reasoning is to go & get another, instead of their behavior being adjusted. They certainly don’t feel that way if someone starts touching a cop in a way they don’t want!
Now, if a cab driver were to drive someone where THEY felt like, especially if the person getting taken there refused to go there, this would be kidnapping & using occupational methods to do so.
The question that no one in medicine or government wishes to ask (or have answered) is how could anything as invasive as pelvic and clinical breast exams become standard practice without any evidence? We are talking about practices that, stripped of medical justification (and with no small amount of coercion) meet the definition of rape and sexual assault.
The second related question is now that we know these practices are unjustified, how is it legal for ACOG to continue to recommend them (and its members to perform them) without facing criminal charges? Want this all to end quickly? Start throwing physicians in jail while ripping up their licenses.
If women are really interested in finding and destroying the “culture of rape”, here is your poster-boy.
I think the answer is that they are simply affirmative of that sort of thing. It’s they way & it just expresses itself in this manner.
Not for nothing, but don’t serial killers come up with all kinds of weird metaphorical bullshit with their actions? One thing or another symbolizes something & they go do it? Well, certainly seems to me that if they were in the medical profession, they’d do the same thing. They’d do antagonistic shit, right? They might try to make it subtle, so that way it doesn’t match the cliche attack (ex: murder usually is thought of as being done with shooting/stabbing/strangling/etc… & not with pills or needles).
The concept that they are saying “Well, in spite of reality, this is this particular way.” It’s like telling a woman with no uterus that she’s going to get uterine cancer (at all), if she doesn’t get tests (that don’t work to detect this situation, much less prevent it on its own), and she’s mentally unfit to handle herself if she argues.
Same sort of thing happens with rectal exams (which they seem pretty keen on forcing on people if they come into the hospital for trauma reasons like crashes & falls or if they have some kind of pain that MIGHT mean they have appendicitis. There was a guy in New York that walked into the hospital to get stitches on his head that got jumped on by five people & had a rectal exam forced on him- the case got thrown out!
The pelvic exam has been raping women for hundreds of years. Yes, it was once part of the yearly pap smear, which has gone to the past, now recommending every 3 years. Women aren’t stupid, and they can learn to look and feel their own vulvas and learn what symptoms would warrant a pelvic exam. No woman needs to be raped each year by a Doctor, who is really only interested in making twice the money for each patient.
My wife couldn’t get her thyroid Rx last December, unless she got naked for a pelvic exam. My wife stood up and walked out. She changed Doctors and didn’t have to have a pelvic exam for her Rx for her Thyroid. The pelvic exam would have doubled the cost of her visit.
Gyn Doctors have chosen to look at naked women all day long. They have the same feelings that anyone else would have, when looking at a beautiful naked woman. Don’t kid your self. They don’t take classes to desensitize their thinking when looking at and putting their fingers into their female patient’s vaginas.
Many Gyn/Doctors will make an excused that the pelvic exam builds trust between the patient and the Doctor. What a lie.!!!!!!!!!!!!!!!!!!!! Not hardly, when these women find out what the truth is and that they have been hiding from them, they will go to a more sensitive Doctor who really cares.
“Do you educate your female patients about the new recommendations (2014) for pelvic exams for healthy, non-pregnant women without symptoms”
It’s interesting that most pelvic exams during pregnancy and childbirth are also, unnecessary.
MOST of these exams do nothing more than cause discomfort/pain, embarrassment and expose women to risk from false positives, over-investigation, and over-treatment. More needs to be done to protect the female body from unnecessary medical intrusion.
“It’s interesting that most pelvic exams during pregnancy and childbirth are also, unnecessary.”
They are not simply unnecessary. A lot of women report miscarriages within hours after pelvic exams, pap smears, and transvaginal ultrasounds. I haven’t been able to find any research that would confirm that these exams are safe during pregnancy and don’t increase the risk of miscarriage. Maybe because there has never been such research and these exams were implemented without any regard for the safety of the baby or its mother?
The only thing I was able to find was that ultrasounds do cause miscarriages as well as subtle damage to the child’s brain and nervous system that could cause cognitive problems later on in life. But I’ve never heard of any doctor disclosing this information to a pregnant woman.
Also, checking cervical dilation before the woman is in labor can lead to premature labor which has its own problems.
A lot of women are catching on to this, though. I’ve seen multiple threads on discussion forums where women who’ve had previous miscarriages after any kind of vaginal exam say that they won’t agree to them during pregnancy anymore. It’s just sad that most women need to lose a few babies to a miscarriage before they learn this lesson.
Some years ago I was looking at manufacturers’ package insert instructions for clinicians for pap swab and brush kits. Most of them did not recommend that their product be used after 8 weeks of pregnancy. I could never find a peer published research article about why the cutoff for paps was recommended at 8 weeks. This is likely because the manufacturers did their own research and never published it. There is plenty of research that is never published for various reasons.
There might be a few reasons to be wary of pap testing during pregnancy. Why the magic number of 8 weeks. Is a pap at 7 1/2 weeks no risk but at 8 weeks it is? Can a pregnance really be THAT ACCURATELY dated? The other reason could be that manufacturers do not want to admit that pap tests can cause miscarriages for legal reasons.
Some doctors just do not care because considering that 50% of all American pregnancies are UNPLANNED then sure they should make money while they can. There might be the odd woman that would be pro life or trying to get pregnant but their excuse will be that a large majority of early miscarriages JUST HAPPEN. It does not seem to be a coincidence the many stories woman have put up on the internet about having a miscarriage two days after a pelvic exam and pap test when they just found out they were pregnant.
I am not sure about the risks of ultrasound but repeated ultrasounds are discouraged. Some of the prenatal tests for birth defects do have a high risk of miscarriage as well they are not very accurate. The idea is pushed that a woman should have more “time” to be prepared for a less than perfect child. Usually they get an abortion.
I am pro life so I have a bias but even those who are prochoice might consider that women should have the right to know the risks and be informed of them. On that note I find it very ironic, when in my country there is no abortion law so abortions can be for any reason, but feminists start screaming when a family wants to have an abortion for gender selection.
My cousin cried out in pain when she was pregnant and they were doing the vaginal ultrasound. It’s like so unnatural and seems so invasive. What’s the point? And I herd the push it around in the vagina that’s got to be terrible .
Both of my pregnancies I’ve forgone prenatal care from an OB til 12-16 weeks. It’s easier to avoid pressure for early ultrasound and preventative screening. Seems like they focus more on your pregnancy and potential baby the further along you are. Early on they just want to look for things that probably aren’t there. Or genetic testing. Yea not interested. I have no regrets and feel it was a responsible decision. Take care of your health, eat well, take your vitamins and listen to your body.
I am pro life. It really bothers me that people have the choice to terminate, but if you cary your baby to term you often face alot of confrontation when you try to dictate what you want while you are pregnant. I can kill it, but if I keep it I have little say in how my pregnancy is managed. And boy do they try to manage it at every opportunity. That’s what a lot of pro choicers are missing. if they’re gonna fight for a women’s right to choose, choice and autonomy should exsist for women at both ends. Choice to terminate should also mean nine months of choices and respect for those who don’t.